CARE HOMES FOR OLDER PEOPLE
Richard House 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD Lead Inspector
Sylvia Brown Unannounced Inspection 09:00 28 November 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Richard House Address 69-73 Beech Road Cale Green Stockport Cheshire SK3 8HD 0161-429 6877 0161 474 0457 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Denmax Limited` Joyce McDonald Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 33 OP. Date of last inspection 21st February 2006 Brief Description of the Service: Richard House is situated in a quiet street across from a local school, close to public transport. The home can accommodate up to 29 older people. Residents have the use of three main lounges with an additional sun lounge, conservatory and seating area at the entrance to the home. The home has been upgraded, redecorated and new fittings and fixtures are in place. Bedroom accommodation has been improved and the home offers 21 single and four double rooms for those who wish to share. A stair lift enables access to the upper floors. The accommodation fees range from £316 to £384. There are currently no top-up fees applied. To the rear of the home is a garden where a decked patio area has been created to offer further outside seating. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection site visit to Richard House was conducted as part of the overall annual inspection process of the home. It was completed in one day, with approximately six hours spent on the premises. Time was spent observing staff practice and interactions with the service users, looking at records, talking with service users about their life at the home and the care they received. The care of two service users were specifically monitored during the inspection. Their records were looked at to see if their needs were recorded and that they were receiving the support they required. Health and safety records were also looked at, as were parts of the building. Comment cards were provided to the home for service users, staff and relatives. At the time of writing, no comments cards had been returned. The next inspection report will incorporate all comments received between this and the next inspection. Service users’ verbal comments received at the inspection have been included in this report. As part of this site visit a ‘Thematic’ probe was undertaken. This is a particular piece of work which looks at various standards and if and how they have impacted on a service user. The information is then used to get a clearer picture across the country on specific aspects of residential and/or care support services. The purpose of this thematic probe was to see if people who used the service: • • • • • • Have been given a copy of the service user guide Receive information about any changes to the cost of their care Been given a copy of their contract Know whether their contract has changed since they have been in the home To see whether the home received or undertook a needs assessment before the resident came into the home To see whether the people who use this service have enough information to help them make a complaint if they wish Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home continues to maintain a good overall standard. The registered manager stated her satisfaction at being able to maintain standards in an increasingly demanding profession. Staff sickness, holidays and vacancies have made some aspects of the home difficult to maintain, particularly administration systems. Notwithstanding, records were readily available and mostly in Reviewing and updating of care plans was underway at the time inspection. The registered manager was reading and adjusting information to ensure the most up to date care needs were recorded on order. of the written file. The care and support of service users has not been affected by staffing difficulties. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5 Standard 6 is not applicable to this home. Quality in this outcome area is good. Service users receive information about the home, have their needs assessed and are able to visit prior to making a decision about their future. This judgement has been made using available evidence, including a visit to this service EVIDENCE: Three service users stated that their families or social workers had arranged their moving into the home, as they preferred to leave them to the initial decision making. One service user stated that they had stayed for a short respite stay and whilst there had decided not to return home. The service user stated the home had provided the social worker with information which had been shared with them. Another stated their family had visited the home and received all the information they required. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 10 When asked no service users wanted any further information. Two service users’ files looked at demonstrated that the registered manager had been to visit the service users in their own home or place of residence and completed an assessment of need. Contracts had been provided which were either signed by the service user or their relative. One relative had consulted legal services regarding the contract to ensure everything was in order. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. Service users have their health and personal care needs recognised, recorded and met. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: All service users have written care plans in place. There were detailed records which demonstrated that health care and personal care issues were discussed with the service user and their preferences for support were recorded. The registered manager is aware of the areas of development which will enhance recorded information and is considering trialling new care plan formats. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 12 Service users spoken with stated they were well looked after. One said that “staff always attend the hospital with her to keep her company” another said “nothing is to much trouble for them”. Throughout the inspection staff were observed supporting service users as they went about their daily routines. Positive relationships and friendships were evident. Service user health is kept under review with their records detailing decreases and improvement in health conditions. Medication administration records were in place and completed correctly. Permission from doctors had been obtained for the administration of specific homely remedies. Doctors’ visits were recorded, as were other health care professionals. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Service users’ lifestyles meet their expectations. They maintain their individuality and have independent friendships and routines. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home does not have a formal activities structure, however service users spoken to stated they were satisfied with what was on offer. One service user took pride in her achievements as she showed the inspector the Christmas and birthday cards she had made at the craft sessions. Service users’ records did not fully record activities undertaken by individuals. Service users stated they have some control over their own lives. They confirmed they chose their own rising and retiring routines and that they can choose where to sit when in communal areas. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 14 One service user said she spends some of the time in communal areas but prefers her own company and watching her own TV in her room. Another lady was observed rising later than the rest. She explained she had had a lie-in as she was up late the previous evening. Family and friends are able to visit in private and stay as long as the service user agrees. One service user informed the inspector that she invites who she likes to her room, including family and friends, and is able to have private times with them. Meals and mealtimes are pleasant experiences in the main. Two meal times were observed. On both occasions everyone appeared to enjoy their meals. A service user stated they had hot food at breakfast, whilst another stated the food was “lovely”. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. Service users are protected from abuse and know how to make complaints. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has a written complaints procedure in place. Records detailed the nature of complaints and action taken to resolve them. When spoke with about complaints, one service user said “there was never anything wrong.” Another stated that they “felt confident that things would be sorted if they made a complaint”. Whilst another commented that they knew how to complain and that they “would tell someone if they were not happy”. Staff receive adult protection training at induction, when completing NVQ training and as provided by the Local Authority. There has been one incident at the home which placed a service user at risk. This was not from a member of staff but persons known to the family. The home acted appropriately in protecting and safeguarding the service user. The inspector had the opportunity of talking with the service user about living at the home. This conversation confirmed that they liked living at the home. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 25 & 26 Quality in this outcome area is good. Richard House is clean and well maintained. Rooms are furnished and offer residents comfort and security. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: On arrival at the home the inspector found it clean and tidy. There were no odours and fresh flowers were evident. During the inspection a service user stated that everything was “always spick and span”. Domestic staff are employed and care staff also assist in maintaining the home’s standards. The lounges and dining areas continue to be nicely furnished, as do service users’ bedrooms. They are personalised according to their own tastes and preferences. Colour schemes are pleasant and rooms inviting. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 17 One service user invited the inspector into their room. The service user stated that they had moved to the room at their own request when it had become vacant. The room had been adapted for the service user who preferred to have a specialised sleeping chair rather than a bed. The home is equipped with hoisting equipment and a stair lift, all of which support service users who have mobility difficulties. Servicing records were in place and all equipment has been assessed as fit for use and safe. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. Staff are recruited, trained and support service users appropriately. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The staffing rota was looked at, there appeared to be sufficient numbers of staff to meet the needs of service users. Care staff are supported by laundry, domestic and kitchen staff. Service users stated they could always get staff when they needed them and it was understandable if they were delayed when seeing to others. Without exception, all service users spoke positively about the staff team and the support they received. Staffing records were looked at, particularly the recruitment and selection of staff. Staff appeared to have been recruited correctly, in that, application forms were in place, as were statutory checks. Letters of appointment were evident which detailed the interview process. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 19 Application forms need developing to ensure all the required information is requested under equal opportunities and employment law. Also, a minimum of two references should be in place. Of the two files looked at, both only had one reference evident. Training and development records need improvement; there was insufficient information on file to identify what training had been completed, planned for and desired or required. One staffing record did not contain a signed contract of employment. Staff continue with their NVQ training with three staff commencing NVQ training at level 2 this year and one commencing level 3. Service users spoken with spoke fondly of the staff team. Observations were that they completed their duties in a calm and friendly manner throughout the inspection. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. The home is well managed and run in the best interest of service users. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: There are no changes to the management structure at the home. The registered manager has been at the home for some considerable time and is experienced in caring for older people. She continues to take an active part in the day to day routines of service users and staff, and is known to all service users. There is also a senior management team who support the running of the home. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 21 The registered manager has a strong leadership style which ensures that routines in the home are based around the needs of service users and that their best interests are served. Service users have been asked to make comments on the service by the home, however there is currently no report on the outcome of the consultation process. Residents receive support from their family and/or placing authority to manage their finances. The home has minimal involvement with residents’ money. Systems for ensuring both day and night time staff receive formal one to one supervision no less than six times a year should be introduced. Accidents records were looked at. Information was recorded about all occurrences, the records being maintained on residents’ individual files. Health and safety records confirmed all major appliances and services to the home are inspected and serviced at the appropriate frequency. Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 X X 3 Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP12 Good Practice Recommendations The registered person should introduce formalised systems and structures for the home’s activities. Such structures will enable both service users and staff to plan for events. All activities undertaken should be recorded within the individuals’ records. The registered person should ensure that recruitment and selection documents contain the required information and that a minimum of two references are received prior to employment. Contracts should be returned after signing and maintained on file. The registered person must ensure that effective quality assurance and quality monitoring systems, based on seeking service users views, are in place, as detailed within Standard 33. The registered person should ensure staff receive formal supervision no less than six times per year and more frequently if required. 2 OP29 3 OP33 4 OP36 Richard House DS0000008583.V319794.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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